When Madison Minton was six months old, her parents noticed that her breathing was frequently labored. Now in second grade, the child is on eight medications for asthma and other pulmonary ailments.

“Madison’s situation is typical,” says Deborah Payne, Energy and Health Coordinator of the Kentucky Environmental Foundation. “People in Eastern Kentucky often don’t have the financial capacity to move away so they live with the consequences of being downwind of a coal processing plant. This means that Madison is exposed to high quantities of dust every single day.”

Payne calls coal mining “one piece of the birth defect puzzle” and says that at every stage, coal is problematic, from its extraction, to its processing, transport, and eventual burning. “At each step there are negative health consequences for adults, children, and fetal life,” she continues.

And it’s gotten worse. As mountaintop removal [MTR] has horned-in on underground mining, the health maladies of residents of eastern Kentucky, southwest Virginia, eastern Tennessee, and southwest West Virginia—Appalachia—have begun to pile up.

Here’s why. MTR requires the use of explosives to reach coal streams, a process that makes it even more perilous than underground mining. According to Physicians for Social Responsibility [PSR], MTR blasts release selenium, iron, and aluminum into the air. Selenium is particularly hazardous, PSR says, because it accumulates in tissue where it can cause circulatory, kidney, liver, and nerve damage.

But that’s not all: Later, chemically treated liquids are used to wash the coal and, more often than not, this brew ends up in groundwater. Even more frightening, a group called Appalachian Mountain Advocates estimates that when the time comes to turn coal into electricity, arsenic, cadmium, lead, and mercury -- in the form of coal ash -- gets spewed into the oxygen we breathe and the water we drink.

Not surpringly, this hasn’t fazed the coal companies. In fact, by all accounts, MTR has been a boon for them, allowing the removal of two-and-a-half times more coal per hour than traditional underground mining. Already, the rush to extract -- four million tons a year is taken from each coal-rich county -- has cleared nearly 2200 square miles of forests, reduced 470 mountain summits to rubble, buried 2000 miles of streams, and damaged the ecosystems needed by fish and wildlife.

Still, it is the human toll that is causing the lion’s share of brow furrowing. A first-of-its-kind study released in June 1011 -- “The Association Between Mountaintop Mining and Birth Defects Among Live Births in Appalachia, 1996-2003” -- brought six scientists together to analyze more than 1.8 million hospital birth records for the central portion of the region.

Their findings should jolt both advocates of reproductive justice and those who purport to support the right to life. Indeed, the scientists were cautious, recognizing that most birth defects come from a mix of genetic and environmental factors. Nonetheless, in areas where MTR is used, health abnormalities -- including spina bifida, heart, lung, and genital malformations, cleft palate, hydrocephalus, and club feet -- greatly exceeded defects in non-MTR areas: 235 per 10,000 versus 144. The study also found that living in an area with mountaintop removal increases the chance of having a child with a circulatory defect by 181 percent.

Adults, researchers say, also suffer. Numerous health surveys have confirmed that adults living in areas where there is mountaintop removal have significantly more illnesses than others of comparable age -- with high rates of diabetes, Chronic Obstructive Pulmonary Disease, asthma, liver disease, hypertension, heart problems, and kidney failure. Factor in poverty -- which affects nearly a third of Appalachia’s residents -- and it’s hard not to despair.

Despite these realities, scientists say that they still have a lot to learn about the risks associated with MTR. “We have not yet investigated the health of pregnant women,” says Dr. Michael Hendryx, Director of the West Virginia Rural Health Research Center. “We know that at certain times during pregnancy there is a greater risk of toxins passing through the placenta. That has to be studied. Throughout Appalachia we hear stories about kids developing cancer at early ages, having asthma and other serious respiratory symptoms, getting frequent rashes and skin blisters. We also hear about kids with digestive and dental problems, kids losing their adult teeth while they’re teenagers. If they drink water from a well that water is usually not treated and we suspect that it is tainted by chemicals that come off a mining site and then rot their teeth. Other people have different kinds of air-related problems. In some places people have to wipe a thick layer of coal dust-- it comes from the processing plants--off their furniture every day or two. The health problems vary depending on what people are exposed to -- but they need to be documented and then analyzed.”

That said, some facts are incontrovertible: For one, coal-mining communities experience significantly more birth defects than communities where mining doesn’t occur. Secondly, adults living in MTR districts are, on average, sicker than adults who live elsewhere.

So what to do? Coal is currently responsible for generating almost half of the electricity used in the US, something that is unlikely to change unless viable alternatives are developed. At the same time, the companies that see coal as a cheap and abundant fossil fuel need to be reminded that here is nothing cheap about human health.

When I was a kid my grandmother frequently repeated a phrase that I found ridiculous: “If you have your health, you have everything.” Who would have imagined that, years later, that truism would resonate.

Eleanor J. Bader teaches English at Kingsborough Community College in Brooklyn, New York. She is a 2015 winner of a Project Censored award for "outstanding investigative journalism" and a 2006 Independent Press Association award. The coauthor of Targets of Hatred: Anti-Abortion Terrorism, she presently contributes to Lilith, Rewire, Theasy.com and other progressive feminist blogs and print publications.

When Madison Minton was six months old, her parents noticed that her breathing was frequently labored. Now in second grade, the child is on eight medications for asthma and other pulmonary ailments.

“Madison’s situation is typical,” says Deborah Payne, Energy and Health Coordinator of the Kentucky Environmental Foundation. “People in Eastern Kentucky often don’t have the financial capacity to move away so they live with the consequences of being downwind of a coal processing plant. This means that Madison is exposed to high quantities of dust every single day.”

Payne calls coal mining “one piece of the birth defect puzzle” and says that at every stage, coal is problematic, from its extraction, to its processing, transport, and eventual burning. “At each step there are negative health consequences for adults, children, and fetal life,” she continues.

And it’s gotten worse. As mountaintop removal [MTR] has horned-in on underground mining, the health maladies of residents of eastern Kentucky, southwest Virginia, eastern Tennessee, and southwest West Virginia—Appalachia—have begun to pile up.

Here’s why. MTR requires the use of explosives to reach coal streams, a process that makes it even more perilous than underground mining. According to Physicians for Social Responsibility [PSR], MTR blasts release selenium, iron, and aluminum into the air. Selenium is particularly hazardous, PSR says, because it accumulates in tissue where it can cause circulatory, kidney, liver, and nerve damage.

But that’s not all: Later, chemically treated liquids are used to wash the coal and, more often than not, this brew ends up in groundwater. Even more frightening, a group called Appalachian Mountain Advocates estimates that when the time comes to turn coal into electricity, arsenic, cadmium, lead, and mercury -- in the form of coal ash -- gets spewed into the oxygen we breathe and the water we drink.

Not surpringly, this hasn’t fazed the coal companies. In fact, by all accounts, MTR has been a boon for them, allowing the removal of two-and-a-half times more coal per hour than traditional underground mining. Already, the rush to extract -- four million tons a year is taken from each coal-rich county -- has cleared nearly 2200 square miles of forests, reduced 470 mountain summits to rubble, buried 2000 miles of streams, and damaged the ecosystems needed by fish and wildlife.

Still, it is the human toll that is causing the lion’s share of brow furrowing. A first-of-its-kind study released in June 1011 -- “The Association Between Mountaintop Mining and Birth Defects Among Live Births in Appalachia, 1996-2003” -- brought six scientists together to analyze more than 1.8 million hospital birth records for the central portion of the region.

Their findings should jolt both advocates of reproductive justice and those who purport to support the right to life. Indeed, the scientists were cautious, recognizing that most birth defects come from a mix of genetic and environmental factors. Nonetheless, in areas where MTR is used, health abnormalities -- including spina bifida, heart, lung, and genital malformations, cleft palate, hydrocephalus, and club feet -- greatly exceeded defects in non-MTR areas: 235 per 10,000 versus 144. The study also found that living in an area with mountaintop removal increases the chance of having a child with a circulatory defect by 181 percent.

Adults, researchers say, also suffer. Numerous health surveys have confirmed that adults living in areas where there is mountaintop removal have significantly more illnesses than others of comparable age -- with high rates of diabetes, Chronic Obstructive Pulmonary Disease, asthma, liver disease, hypertension, heart problems, and kidney failure. Factor in poverty -- which affects nearly a third of Appalachia’s residents -- and it’s hard not to despair.

Despite these realities, scientists say that they still have a lot to learn about the risks associated with MTR. “We have not yet investigated the health of pregnant women,” says Dr. Michael Hendryx, Director of the West Virginia Rural Health Research Center. “We know that at certain times during pregnancy there is a greater risk of toxins passing through the placenta. That has to be studied. Throughout Appalachia we hear stories about kids developing cancer at early ages, having asthma and other serious respiratory symptoms, getting frequent rashes and skin blisters. We also hear about kids with digestive and dental problems, kids losing their adult teeth while they’re teenagers. If they drink water from a well that water is usually not treated and we suspect that it is tainted by chemicals that come off a mining site and then rot their teeth. Other people have different kinds of air-related problems. In some places people have to wipe a thick layer of coal dust-- it comes from the processing plants--off their furniture every day or two. The health problems vary depending on what people are exposed to -- but they need to be documented and then analyzed.”

That said, some facts are incontrovertible: For one, coal-mining communities experience significantly more birth defects than communities where mining doesn’t occur. Secondly, adults living in MTR districts are, on average, sicker than adults who live elsewhere.

So what to do? Coal is currently responsible for generating almost half of the electricity used in the US, something that is unlikely to change unless viable alternatives are developed. At the same time, the companies that see coal as a cheap and abundant fossil fuel need to be reminded that here is nothing cheap about human health.

When I was a kid my grandmother frequently repeated a phrase that I found ridiculous: “If you have your health, you have everything.” Who would have imagined that, years later, that truism would resonate.

Eleanor J. Bader teaches English at Kingsborough Community College in Brooklyn, New York. She is a 2015 winner of a Project Censored award for "outstanding investigative journalism" and a 2006 Independent Press Association award. The coauthor of Targets of Hatred: Anti-Abortion Terrorism, she presently contributes to Lilith, Rewire, Theasy.com and other progressive feminist blogs and print publications.